Author: Kai Valonen
Organisation: Safety Investigation Authority
To gain an overview of drowning in Finland by investigating a) the circumstances that drowning occurs in b) which people are at highest risk of drowning and c) what approaches can be taken to prevent drowning.
Finland is a water-oriented society with high mortality in aquatic settings. According to World Health Organisation data, Finland continues to have, despite a downward trend, one of the highest drowning rates (3.8 per 100.000 population) among high-income countries. Finland’s extensive medico-legal system and high autopsy rates provide an excellent platform for studies investigating injury. However, the existing data collected on drowning cases is insufficient for developing effective preventive countermeasures.
The Safety Investigation Authority (SIA) is an independent state authority, connected to the Ministry of Justice in Finland. It investigates all serious incidents/accidents with a goal of improving the general safety of the Finnish population. It has three major departments: aviation, maritime and railway. In 2010, the Accident Investigation Board launched a safety study to gather information on the deaths by drowning that occurred nationally during a single year.
By means of a centralized police database, all information concerning a body found in water between the 1/4/2010 and the 31/3/2011 were selected for analysis. These selected cases were screened, with outcomes of medico-legal investigations used to identify cause and manner of death. All cases of drowning deaths were subsequently analysed by a multidisciplinary team using an ad hoc questionnaire which gathered further information on each case from the police and the from the victim’s relatives. Questions investigated the circumstance of the incident, including weather conditions, supervision, the victim’s ability to swim and the use of a personal flotation device.
The total of 329 drowning deaths were reported, of which 228 (69%) were considered to be accidental deaths. approximately 73 (22%) of the incidents were classified as suicides, 17 (5%) as natural deaths due to disease, and 8 (2%) as suspected homicides, or cases of the victim being forced into water. The cause of three deaths (1 %) remained unclear.
The three main categories of accidental, water-related deaths were swimming-related accidents (32%), boating-related accidents (30%) and slipping, falling and stumbling into water (25%). Most swimming-related incidents occurred while people were bathing in coastal shorelines. The majority of boat-related accidents occurred close to the shore and were among small boat operators. Seven percent of fatal drowning cases occurred as result of people falling through ice, half of which did not involve a vehicle. Totalling slightly over 6 per cent, the remaining incidents involved entering water in a vehicle (including bicycles) or were bathtub drownings.
As main outcomes of the project, seven key recommendations were made to reduce the burden of drowning in Finland, focusing on:
- Establishing drowning reduction targets.
- Improving data acquisition for drowning related deaths.
- Blood alcohol limits during boating.
- Blood alcohol limit surveillance at lakes.
- Use of flotation devices for rowing boat users, possibly through means such as regulatory guidelines.
- Swimming instruction at schools.
- Systematic safety communication via the Finnish Broadcasting Company (YLE).
It was difficult to determine the details of many drowning cases. Victims were often found in water with no one able to confirm how or why the incident had occurred. It was difficult to assign drowning cases into clear categories. For example, if a person was riding a bike when they fall off a bridge into water and drowned, is this a road traffic injury, fall or drowning incident? In some cases, the cause of drowning deaths may have been alternatively reported as trauma.
For similar future projects, a smaller number of drowning cases would be included in the study, allowing for more detail to be gathered around each drowning case included in the analysis. The system used for categorising drowning cases has now been refined, allowing for a smoother and faster classification process.
It is possible to implement a similar study in other parts of the world however, this type of investigation requires information from autopsy reports, police records and rescue service reports. In many cases, this information is highly protected or is simply not available at a reliable quality.
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